Conclusion

Five evidence-based guidelines on adult tracheostomy management were identified. This may represent a paucity of evidence on the subject, suggesting that further clinical trials on the topic are needed to contribute to the evidence-base. In addition, this highlights the need for international consensus in the area, to reduce duplication of efforts, standardise practice, and improve outcomes.

Evidence-based guidelines and protocols for the management of adult patients with a tracheostomy: a systematic review.

Introduction

Rigorous and protocol-based care of the adult patient with a tracheostomy is important, both within hospital and in the community; adverse events, although rare, confer a high rate of mortality [1]. Although many informal or local guidelines and protocols exist, little is known regarding the existence and availability of formal evidence-based guidelines on adult tracheostomy care.  

The aim of this study was to perform a preliminary systematic review for evidence-based guidelines on adult tracheostomy care.

Table 1

Siddiqui J1, Sherren PB2, Birchall MA3. 1. Northwick Park Hospital, North West London Hospitals NHS Trust, London, UK

2. Royal Free Hampstead NHS Trust, London, UK

3. Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK

Results

The search results are summarised in table 1.

A total of 80 guidelines were identified and five were found to satisfy the AGREE II criteria. Of these, only three related to the entire spectrum of tracheostomy management.The majority were informal, ad-hoc guidelines that were not published or evidence-based.

Methods

A systematic search of Pubmed, Medline, guideline clearinghouses, centres of evidence-based practice, and professional societies’ guidelines relating to care of adult patients with a tracheostomy was performed by two reviewers. In addition, a Google search of publicly available tracheostomy care guidelines and protocols was performed.

Search terms: (Tracheostom* OR tracheotom*) AND (protocol* OR guideline* OR standard* OR management OR consensus OR algorithm*).

Filters: English language, Human, from 01/01/1990 to date, adult patients.Guideline appraisal criteria: The quality of guidelines retrieved was assessed using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument [2], utilising criteria 8 and 12 of the rigour of development domain.

References1.McGrath BA et al. Anaesthesia. 2012 Sep;67(9):1025-41.

2.The AGREE Collaboration. 2001. Appraisal of Guidelines for Research and Evaluation: Instrument. AGREE II. http://www.agreetrust.org/

  Database

 Total results

 Results with

limits 

 Full texts retrieved

 Guidelines found

 

 AGREE

instrumentcompliant

 Pubmed 

 4685

 1596

 33

   

26

   2 

Medline 

 3859

 1337

 17

 CINAHL 

 733

 172

 6

 Medical Societies / Guideline websites /Clearinghouses 

  

N/A

  

N/A

  

N/A

  

 54

   3

 Google

 17,600,000

 497

 N/A